Hospitals Make Strides To Show Meaningful Use: ONC

Vast majority have adopted certified electronic health record technology, but most EHR systems are not comprehensive, ONC says.

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Hospitals are making good progress acquiring and implementing basic electronic health record (EHR) systems that are capable of showing meaningful use, but only a small minority have comprehensive EHRs, according to a pair of new reports from the Office of the National Coordinator of Health IT (ONC).

Between 2009 and 2012, the ONC data shows, the number of non-federal acute care hospitals that had at least a "basic" EHR more than tripled from 12% to 44%. It was in 2009 that Congress passed the HITECH Act, which authorized government incentive payments to hospitals and doctors for making meaningful use of EHRs.

Basic EHRs, as defined by the ONC, include clinician notes but not clinical decision support tools or the ability to order lab or imaging tests or specialty consultations electronically. Those are features of comprehensive EHRs, which were used by 17% of hospitals in 2012, compared to nearly 3% in 2009.

The percentage of hospitals that had certified EHR technology rose from 72% in 2011 to 85% in 2012, the ONC pointed out. The reason why these numbers are so much higher than those for basic and comprehensive EHRs is that they include hospitals that had only certain parts of EHRs certified for meaningful use.

Hospital adoption of EHR systems varied across the U.S. The rates of adoption of at least basic EHRs were above the national average in 12 states and below average in 11 other states. The states with the highest adoption rates were South Dakota, Rhode Island and Colorado. New Hampshire, New Mexico and Kansas had the lowest adoption rates.

The other ONC report found that hospital adoption of EHR technology capable of meeting meaningful use objectives increased substantially from 2008 to 2012. Hospitals' capabilities to meet seven of the technology goals grew significantly, with increases ranging from 32% to 167%. The capability that increased the most was the ordering of medications through computerized provider order entry (CPOE).

In 2012, the report said, hospital adoption rates for each of the 14 stage 1 core objectives ranged from 72% to 94%. For all but one of these objectives, adoption increased by at least 20% from 2011 to 2012.

The high rates show the extent to which hospitals are focusing on the implementation of health IT that qualifies them for incentive payments. In contrast, the most recent ranking of hospital EHRs by HIMSS Analytics shows that providers are making slower progress across the gamut of EHR capabilities than the ONC data indicates.

As of the fourth quarter of 2012, HIMSS Analytics' data shows, 38% of hospitals were in stage 4 or higher of the research firm's seven-stage EMR adoption model. That includes all of the providers that had CPOE, which is a core requirement in meaningful use stage 1. In contrast, ONC found that the percentage of hospitals that had CPOE systems for medication ordering rose from 51% in 2011 to 72% in 2012. But it's unclear how many of these hospitals would have met HIMSS Analytics' stage 4 criteria for CPOE, which also includes test ordering. In addition, many facilities still lack clinical decision support and information exchange capabilities.

However, it appears that hospital leaders are increasingly confident about their ability to meet the requirements for meaningful use stage 2. A few months ago, a KPMG survey found that 47% of healthcare executives were only "somewhat confident" about their ability to meet these criteria. But in the recently released annual HIMSS survey of CIOs, 66% said their institutions had attested in stage 1 of meaningful use, and 75% said they plan to attest in stage 2.

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It seems to me that most providers are installing the EHRG«÷s with the sole objective of attesting to Meaningful Use. Incentive payments seem to be the basis for the decisions, rather than using the full capabilities available with EHR technology. It will be interesting to see what happens as we get closer to Meaningful Use 2.

This kind of analysis will be increasingly important as we assess healthcare IT. The vast majority of provides will have some level of electronic records -- but when you say you have electronic records, what does that mean? And what is that technology letting you do that you couldn't do before?